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Nutrition, Growth and Development

Nutrition, Growth and Development. Classification System . Low Birth Weight (LBW) <2500 grams or 5.5 pounds Very Low Birth Weight (VLBW) <1500 grams of 3.3 pounds Extremely Low Birth Weight (ELVW <1000 grams or 2.2 pounds. Classification System . Small for gestational age (SGA)

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Nutrition, Growth and Development

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  1. Nutrition, Growth and Development

  2. Classification System • Low Birth Weight (LBW) • <2500 grams or 5.5 pounds • Very Low Birth Weight (VLBW) • <1500 grams of 3.3 pounds • Extremely Low Birth Weight (ELVW • <1000 grams or 2.2 pounds

  3. Classification System • Small for gestational age (SGA) • Birthweight less than the 10th %tile • Appropriate for gestational age (AGA) • Birthweight between 10th and 90th %tile • Large for gestational age (LGA) • Birthweight greater than the 90th %tile

  4. Infant Growth • Occurs in genetically predetermined way • Can be compromised by nutritional status • calorie or nutrient undernutrition or imbalance. • Undernutrition: • First affects weight gain • If severe enough, affects linear growth

  5. Growth • After birth genetic influences are target seeking • Catch Up Growth: Grow faster to get closer to genetically determined size • Usually shift growth channels by 3 to 6 months • Lag Down Growth: • Usually shift growth channels by 13 months

  6. Rules of Thumb • Weight: • 4 months: Double birth weight • 12 months: Triple birth weight • then 2.3 kg/year until 9 or 10 • then adolescent growth spurt

  7. Growth: Height • 1 year: 50% increase in height • 4 years: double birth length • 13 years: triple birth length • Adolescence: rapid increase

  8. Adolescent Growth Spurt • 2 years later in males than females • intensity, duration highly variable • Growth continues until after the epiphysis closes • Generally by 4 years post onset of puberty

  9. Body Proportions • At birth: Head 1/4 of total length • Leg 3/8 of total length • When growth ceases: • Head 1/8 of total length • Leg 1/2 of total length

  10. Collecting and Assessing Food Intake • 24-hour recall • Diet history • Diet Record 1, 3 and 7 day or more • FFQ

  11. Who should be asked about Diet Intake? • If the subject is a boy < 13 or 14 years of age, the caregiver should be asked. • If a girl under 12 years of age, caregiver. • Why?

  12. After diet has been taken accurately, then analysis is required • How? • Food Guide Pyramid • Nutrient analysis using food composition table/ computer analysis • Micaelsen room 104

  13. Red Flags • Anthropometric: ht or wt less than 5th %tile • Infant formula under or over diluted • whole cow’s milk before 1 year • reduced fat cow’s milk before 2 years • semi-solid foods before 4 months • bottle fed to go to sleep

  14. Other Assessments Made • parent’s nutrition knowledge • adequacy of foods offered • parent’s knowledge of community services • delays in feeding skills • behavior patterns that affect intake • motivation of parent for change

  15. Feeding problem: organic or inorganic • Organic: problem with muscle coordination, development • Inorganic: stress in family, emotional • Occupational therapists, speech pathologists are trained to make these types of evaluations: if feeding problem exists, you may need to make a referral to determine cause.

  16. Organic Feeding Problems

  17. Moving Death, divorce, separation Marriage, pregnancy Serious injury or illness Loss of work Family fights Money problems Drinking Trouble with the law Other serious problems Stressors

  18. Parents of Maladjusted Children • Often are: • younger • more dependent on relative • unstable mentally • have marital or other conflicts • have a disturbed relationship with their child

  19. Infant Feeding Choice • Breast feeding best choice but • approx. 80 % of infants receive formula at sometime during first year • types of formulas available: • ready to serve • concentrated • powdered

  20. Formulas: types • Source of Formula and Use • Cow’s milk based formulas. • Soy based formulas. • Specialized formulas.

  21. Cow’s Milk Formulas • 2 types: • 1. Protein diluted to reach amount in human milk • add back CHO, Fat, vitamins and minerals • 2. Casein diluted to reach amount in human milk • add back lactalbumin, fat, vitamins and minerals

  22. Soy Based and Specialized Formulas • Soy protein used as the protein base • add back CHO, fat, vitamins, minerals, and methionine (limiting amino acid) • e.g.: Prosobee • Specialized: For special needs • e.g.: Lofenalac: used with PKU infants • Low in phenylalanine

  23. Osmolality • Measure of solute in solvent • e.g.: particles in milk • osmolality: osmoles of solute in 1 kg of solvent • osmole: solute that dissociates in solution to form one mole (Avogadro’s number) of particles. • If too high: water sucked out and causes diarrhea

  24. Osmolality & Renal Solute Load • Human milk: low, less than 300 mosmolar, gut can easily handle • Creates Renal Solute Load of 13 mosmol/100kcal • Cow’s milk: Higher osmolality • Renal Solute Load of 46 mosmol/100kcal • Skim milk: RSL of 86 mosmol/100kcal • Formulas: 18-27 mosmol/100kcal

  25. Potential Problems: • Mixing formulas too strong (or weak) • Skim milk to infants or children under 2 yo • Whole milk under 1 yo

  26. Nutrient Needs of Children • Energy Needs based on: • body size and composition • physical activity • rate of growth • surface area to volume ratio • Infancy more surface area to volume then later in life • More loss of energy to surrounding environment

  27. Energy • Age Energy • < 6 months kg x 108 • 6mo-1 year kg x 98 • Consider range of intake of intake requirements

  28. Protein • Infant requirements based on amount found in breast milk • Extrapolation from nitrogen balance studies • RDA’s • Age Protein • <6 mo 2.2 g/kg • 6-12 months 1.6 g/kg

  29. Fat • No RDA but 40 to 50 % of infant Kcals • Fat energy spares protein from being used as an energy source • 45 to 50 % of infant formulas kcals are from fat • 55% of human milk kcals are from fat • Essential fat recommendation > 1.2% of kcals (linoleic and linolenic acid)

  30. When to reduce fat intake in kids? • Fat shouldn’t be a concern until after 2 years of age. • Then start incorporating lower fat food items into the diet • reduced fat milk and milk products are ok • If these are accepted early, the risk of chronic disease could be reduced • Controversy: Am Ac of Pediatrics says don’t worry until after puberty: too late

  31. Water • Age Amount • 3 days 80-100 ml/kg/day • 10 days 125-150 ml/kg/day • 3 mo 140-160 ml/kg/day • 6 mo 130/155 ml/kg/day • 9 mo 125-145 ml/kg/day • With BF and formula: none additionally needed

  32. Iron(Fe) • In the fetus, Fe stores are related to body size, therefore lbw and premature babies are at increased risk for iron deficiency • Human milk: 49% of iron is absorbed, only 1% of cow’s milk • Human milk not a very good source of Fe so after 4 to 6 months, baby may be deficient in Fe. Iron fortified cereals with vitamin C.

  33. Fluoride(Fl) • Major role in tooth and bone development • Adequate intake reduces dental decay • Becomes incorporated in tooth and resists acid breakdown. Acid produced by cariogenic bacteria in mouth. • Supplementation dependent on Fl in water supply.

  34. Fluoride Supplementation • Amount in Water age supplement • < 0.3 ppm 2 wk-2 y 0.25 mg/day • 2-3 years 0.5 mg/day • after 3 y 1.0 mg/day • 0.3-0.7 ppm 2 to 3 y 0.25 mg/day • 3-16 years 0.5 mg/day • over 0.7 no supplementation

  35. Age of Introduction of Solid Foods • Developmental readiness, generally 4 to 6 months • depends on oral skills: tongue thrust, munching pattern, brings objects to mouth • palmer grasp develops • interest: if child reaches for food • First Foods: iron-fortified cereals for infants • 6-8 months: strained vegies, fruits, meats, finger foods

  36. Adding Foods • New foods should be added one at a time, no more than one every three days • Check for tolerance • As infant approaches 9 to 12 months, increase in texture to mashed and finger foods can progress • Avoid potential choking foods • hot dogs

  37. Feeding Problems • Colic: gas production, and bloating • Cause? Not always known: formula fed, may change formula to casein hydrolysate • but not always successful • Breastfeeding? • Foods in the mother’s diet • Cow’s milk, or items

  38. Colic

  39. Spitting up • Normal occurrence • Unless projectile vomiting: • Organic problem: pyloric sphincter closure • What You Should Know About Gastroesophageal Reflux (GER) in Infants and Children - December 1, 2001 - American Academy of Family Physicians

  40. Screening Infants for special needs • Nursing Bottle Syndrome: feeding baby to go to sleep with bottle • Increases tooth decay • Treatment: don’t put baby to bed with a bottle • Infant Obesity:>95%tile wt for age, Wt for ht • Not predictive of obesity in later life • Adequate nutrition should be the key: don’t restrict foods

  41. Neonatal Care • Level 1: uncomplicated births and healthy infants • Level 2: normal infants and expertise in screening and referral of high risk infants • care for moderately ill neonates and convalescing neonates • Level 3: equipped to cope with most serious neonatal problems, illnesses, abnormalities

  42. Role of Nutritionist in Neonatal Care • Should be able to • screen for various nutrition problems, • monitor and assess nutritional progress, • develop and implement nutrition management plans

  43. Failure to Thrive • Failure to regain birth weight by 3 weeks • Wt. loss of >10% of birth weight by 2 wks • Wt dropping below the 3rf %tile • Deceleration of growth velocity • Evidence of malnutrition

  44. Growth Retardation: 4 Types • 1. Small for Gestational age but appropriate growth since • intrauterine growth retardation, but appropriate since then • parental height small stature

  45. Growth Retardation • 2. Small or appropriate for gestational age but subnormal growth velocity • ongoing growth insult • examples: poor intake, overdiluting formula, in appropriate breastfeeding schedule, family stress, poverty

  46. Growth Retardation • 3. Depression in growth velocity • Some transient growth insult but has since been alleviated • Seasonal low intake of nutrients due to low income

  47. Growth Retardation • 4. Deceleration of growth due to lag down • familial short stature

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